Connecting the Dots September 4, 2009 Preventing Mental, Emotional and Behavioral Disorders Among Young People: Progress and Possibilities

2 Committee Members KENNETH WARNER (Chair), School of Public Health, University of Michigan THOMAS BOAT (Vice Chair), Cincinnati Children’s Hospital Medical Center WILLIAM R. BEARDSLEE, Department of Psychiatry, Children’s Hospital Boston CARL C. BELL, University of Illinois at Chicago, Community Mental Health Council ANTHONY BIGLAN, Center on Early Adolescence, Oregon Research Institute C. HENDRICKS BROWN, College of Public Health, University of South Florida E. JANE COSTELLO, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center TERESA D. LaFROMBOISE, School of Education, Stanford University RICARDO F. MUNOZ, Department of Psychiatry, University of California, San Francisco PETER J. PECORA, Casey Family Programs and School of Social Work, University of Washington BRADLEY S. PETERSON, Pediatric Neuropsychiatry, Columbia University LINDA A. RANDOLPH, Developing Families Center, Washington, DC IRWIN SANDLER, Prevention Research Center, Arizona State University MARY ELLEN O’CONNELL, Study Director

3 Committee Charge Review promising areas of research Highlight areas of key advances and persistent challenges Examine the research base within a developmental framework Review the current scope of federal efforts Recommend areas of emphasis for future federal policies and programs of research

4 Explosion in Randomized Trials

5 A Central Theme “The scientific foundation has been created for the nation to begin to create a society in which young people arrive at adulthood with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships with others.”

6 “The gap is substantial between what is known and what is actually being done” We call on the nation to build on the extensive research now available by implementing evidence-based preventive interventions testing their effectiveness in communities dissemination prevention principles addressing gaps in available research monitoring progress at the national, state, and local level

7 Disorders Are Common and Costly Around 1 in 5 young people (14-20%) have a current disorder Estimated $247 billion in annual treatment and productivity costs Other costs education, justice, health care, social welfare costs to the individual and family

8 Preventive Opportunities Early in Life Early onset (¾ of adult disorders had onset by age 24; ½ by age 14) First symptoms occur 2-4 years prior to diagnosable disorder Common risk factors for multiple problems and disorders

9 Core Concepts of Prevention 1. Prevention requires a paradigm shift 2. Mental health and physical health are inseparable 3. Successful prevention is inherently interdisciplinary 4. Mental, emotional, and behavioral disorders are developmental 5. Coordinated community level systems are needed to support young people 6. Developmental perspective is key

Preventive Intervention Opportunities 10

11 Evidence that Disorders Can be Prevented Multi-year effects on substance abuse, conduct disorder, antisocial behavior, aggression and child maltreatment Indications that incidence of adolescent depression can be reduced Interventions that target family adversity reduce depression risk and increase effective parenting Emerging evidence for schizophrenia

12 Evidence of School-related Effects School-based violence prevention can reduce aggressive problems by one- quarter to one-third Social and emotional learning programs may improve academic outcomes When information is available, benefits far exceed costs

13 Implementation Need to move from efficacy toward effectiveness and implementation trials Implementation research has highlighted: complexity important role of community Implementation needed at multiple levels Program, Policy, Principles Research

14 Implementation: Programs, Policies, and Principles Public education Fund evidence-based programs Implement policies that support families, address poverty & support healthy development Adopt key principles Eliminate or reduce exposure to toxic events (e.g., harsh discipline, abuse/neglect) Positive reinforcement of prosocial behavior and creation of nurturing environments by families, schools, communities Reinforce positive behaviors (e.g., diet, exercise, limited tv viewing; adequate sleep)

15 Program Implementation: Three General Approaches Implement an existing evidence-based program Adapt an existing program to community needs Community-driven implementation But, evaluation and ongoing knowledge development critical

16 Implementation: Research Priorities Effectiveness and implementation trials Community involvement and community- driven models Moving to scale Adaptation Identify core elements

17 Recommendation Themes Putting Knowledge into Practice Continuing Course of Rigorous Research

18 Putting Knowledge Into Practice: Overarching Recommendations Make healthy mental, emotional, and behavioral development a national priority Establish public prevention goals White House should establish ongoing multi- agency strategic planning mechanism Align federal resources with strategy States and communities should develop networked systems

19 Putting Knowledge Into Practice: Data Collection and Monitoring HHS should provide annual prevalence data and data on key risk factors SAMHSA should expand collection of data on service use (and local monitoring systems needed to guide local efforts)

20 Putting Knowledge Into Practice: Funding Prevention set-aside in mental health block grant Braided funding Fund state, county, and local prevention and promotion networks

21 Putting Knowledge Into Practice: Funding (Cont’d) Target resources to communities with elevated risk factors Facilitate researcher-community partnerships Prioritize use of evidence-based programs and promote rigorous evaluation across range of settings

22 Putting Knowledge Into Practice: Workforce Development HHS, ED, and Justice should develop training guidelines Set aside funds for competitive prevention training grants Professional training programs should include prevention Certification and accrediting bodies should set relevant standards

23 Continuing a Course of Rigorous Research:Overarching Recommendations NIH should develop comprehensive 10- year prevention and promotion research plan Research funders should establish parity between research on preventive interventions and treatment interventions

24 Additional Information Report available at: Summary available as free download Webcast, materials from March 25 dissemination event, and report briefs available at Two current report briefs: policymakers and researchers Two future report briefs: parents and benefit- cost